Provider Demographics
NPI:1063667186
Name:NEHILLA, AMANDA L (OT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:NEHILLA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9009 CASCADE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5369
Mailing Address - Country:US
Mailing Address - Phone:919-529-4288
Mailing Address - Fax:
Practice Address - Street 1:12450 CLEVELAND RD STE 206
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-8355
Practice Address - Country:US
Practice Address - Phone:919-771-0775
Practice Address - Fax:919-303-3939
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7650225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics